Prevalence and Risk Factors Associated with Malaria among Children Aged Six Months to 14 Years Old in Rwanda: Evidence from 2017 Rwanda Malaria Indicator Survey

Determinants of malaria infection among under five children in Gursum district of Somali region, Eastern Ethiopia

BACKGROUND

Despite significant efforts to control malaria infections in recent years, new infection rates continue to pose a major public health challenge in sub-Saharan Africa, including Ethiopia. This study aims to identify the key factors of malaria infection among children under five years (U5) in the Gursum district of Somali region, Eastern Ethiopia.

METHODS

An institution-based case-control study was conducted over two months, from June to July 2020. The study included 247 participants, divided into 82 cases and 165 controls, with a case-to-control ratio of 1:2. It focused on households with children under the age of five who received care at three health centers within the district. The investigation involved identifying Plasmodium species using rapid diagnostic tests and microscopic blood film examination. A logistic regression model was employed to analyze the factors affecting the outcome, using statistical software STATA-13/15. Odds ratios and the corresponding confidence intervals were calculated to identify potential predictors in the logistic regression model.

RESULTS

A multivariate analysis identified five exposures significantly associated with malaria positivity among children: living near a source of water [adjusted odds ratio (AOR) = 3.60 (1.73-7.48)], residing in rural areas [AOR = 3.58 (1.56-8.21)], living in houses with openings or holes in the walls that facilitate mosquito entry [AOR = 5.00 (2.22-11.28)], and not receiving malaria health information [AOR = 2.12 (1.06-4.21)]. Additionally, proximity to malaria vector breeding habitats [AOR = 4.74 (2.27-9.90)] was significant for malaria positivity. These five factors emerged as the primary determinants of malaria positivity among U5 children in the Gursum district.

CONCLUSION

The study indicates that critical factors contributing to malaria positivity among U5 children in the Gursum district are related to a lack of awareness, housing conditions, and proximity to vector breeding sites. Therefore, social mobilization and targeted malaria interventions at the community level are essential for reducing disease transmission, particularly among the most vulnerable children.

Assessment of malaria transmission in Kenya using multilevel logistic regression

Background

Kenya has a lower malaria incidence in comparison to other African malaria-endemic nations. Malaria is a significant public health concern in the country. The malaria indicator survey (MIS) data were analyzed using the logistic regression model. Nonetheless, independent data may be the cause of most MIS's hierarchical structure. This approach does not consider any association between data points within a cluster, as it assumes that the individual malaria statuses are independent of their causes. The approach may lead to biased analysis conclusions. The primary goal of this research is to determine the impact of sample enumeration areas (SEAs) and SEA features on individual malaria rapid diagnostic test (RDT) results. We are interested in identifying key factors influencing household members' malaria RDT findings or Kenya's malaria prevalence and assessing variation.

Methods

Our study utilized the robust 2020 Kenya National Malaria Indicator Surveys (KMIS) dataset, which is representative of the entire nation. This dataset, comprising 301 clusters (134 urban and 167 rural areas), was instrumental in applying several multilevel models, including random sample and sample Enumeration Area (SEA) effects. We also considered the weights used in the s survey design, which is used to adjust uneven probabilities of choice within clusters, further enhancing the reliability and relevance of our findings. The methods used in this study involved a rigorous analysis of the KMIS dataset, including applying multilevel models and considering survey design weights to ensure the robustness and strength of our results.

Results

This study's findings are significant and crucial in understanding the prevalence of malaria in Kenya. The findings reveal that factors such as region, place of residence, mosquito bed net use, water source location, wealth index, age, household size, and altitude are significantly associated with malaria's prevalence.After accounting for these variables, systematic changes across SEAs accounted for approximately 47.1 % of the remaining variability in malaria occurrence in the study locations. In contrast, the remaining 52.9 % was projected to be unmeasured differences between individuals or family units. These findings provide a detailed explanation of the various processes that influence malaria prevalence in Kenya.

Conclusions

The study's multilevel logistic regression model, which includes random effects, identified two SEA-level and eight individual/household risk factors for malaria infection. Thus, increasing the availability of insecticide-treated bed nets is one crucial element that public health policymakers should consider. Furthermore, health planners can organize spatially targeted initiatives to prevent malaria transmission with the help of spatial clustering data.

Malaria parasitemia and its association with CD4 cells, viral load and haematological parameters among HIV-infected children < 15 years in the Bonasssama Health District, Douala, Cameroon: Prevalence and risk factors

Background

One of the major causes of morbidity and death in children is malaria, and HIV infection and other factors may make the situation worse. This study aimed to assess the prevalence of malaria parasitemia among HIV-infected children under 15 years in the Bonassama Health District, Douala, Cameroon, and investigate its association with CD4 cell counts, viral load, and haematological parameters.

Methods

The study was a cross-sectional study involving 287 HIV-infected children <15 years and convenient sampling was used to enrol participants. A semi-structured questionnaire was used to obtain the characteristics of the participants from the caregivers. Venous blood was collected; blood films were made and stained using Giemsa for parasite detection. Full blood count, CD4 level and viral load were measured using a haematology auto-analyzer, pima counter and genexpert, respectively. Data were analysed using SPSS, and the chi-square test was used to assess the association. Predisposing factors to malaria were evaluated using multivariable logistic regression, and a p < 0.05 was considered significant.

Results

The overall prevalence of malaria and anaemia was 31.01 % and 25.44 %, respectively. Malaria prevalence was significantly higher in children <5 years (42.68 %, p < 0.001), those presented with fever (40.70 %, p = 0.047), children not on antiretroviral therapy (ART) (28.6 %, p = 0.02) and cotrimoxazole (28.6 %, p = 0.02). Children <5 years (AOR = 1.81, 95 % 1.19-2.75), those between 5 and 9 years (AOR = 1.61, 95 % CI 1.11-2.48), children not on ART(AOR = 2.2, 95 % 1.03-4.74) and Cotrimoxazole (AOR = 9.08, 95 % 2.33-43.46), febrile children (AOR = 1.72, 95 % 1.01-2.11), children with viral load >3000 copies/μL(AOR = 2.933, 95 % 1.36-6.49), and CD4 count <200cells/ μL (AOR = 3.09, 95 % 2.08-4.6) were factors associated with malaria parasitemia among HIV-infected children. Haemoglobin levels (p = 0.0016), White Blood Cells (p = 0.002), Red Blood Cells (P < 0.001), neutrophils count (p < 0.001), and platelet counts (p = 0.0164) were significantly lowered among malaria/HIV children compared to HIV-infected children.

Conclusion

The study concludes that HIV-infected children under 5 years, especially those not on ART or cotrimoxazole, are at a significantly higher risk for malaria and related haematological issues. This underscores the necessity for targeted malaria screening and treatment in this vulnerable group. Public health strategies should prioritize enhancing access to ART and cotrimoxazole to mitigate these risks and improve overall health outcomes.

Assessing the burden of submicroscopic Plasmodium infections in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau

BACKGROUND

Submicroscopic Plasmodium infections can be a source of persistent malaria transmission. The aim of this study was to assess their frequency, distribution, morbidity and associated factors in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau, where the Plasmodium falciparum is the predominant Plasmodium species.

METHODS

Dried fingerprick whole blood samples from 601 participants in the 2017 national, household-based, cross-sectional survey to estimate malaria prevalence were subjected to DNA extraction. The DNA was used in nested end-point PCR assays targeting genus- and species-specific regions of the Plasmodium 18S rRNA genes. Statistical analysis of socio-demographic, clinical and molecular data was carried out using the Statistical Package for the Social Sciences, version 29. Factors associated with submicroscopic P. falciparum infections and their magnitude were sought using Chi-square test and multiple logistic regression models, respectively. Statistically significant level was considered at P-value < 0.05.

RESULTS

Nested PCR assays detected submicroscopic P. falciparum infections in 20.3% (95% CI = 16.8-23.8) of individuals microscopically negative for Plasmodium species in the general population and in 21.4% (95% CI = 9.9-36.5) of microscopically negative pregnant women. Submicroscopic Plasmodium malariae infections were also detected as co-infections in 3.0% individuals who were microscopically positive only for P. falciparum. Infections with other Plasmodium species were not detected. Submicroscopic P. falciparum infections were not associated with age, sex, or the presence of fever. A logistic regression model adjusted for ethnicity and health region showed that individuals from the Balanta and Bijagos ethnic groups, most of whom live in the low malaria-transmission areas of Quinara and Bissau, and the Bijagos archipelago, respectively, were less likely to have submicroscopic P. falciparum infections than individuals from the large Fula ethnic group, most of whom live in the high malaria-transmission area of Gabu. Submicroscopic P. falciparum infections were not associated with anaemia in children under 5 years of age.

CONCLUSION

The results obtained highlight the contribution of asymptomatic and submicroscopic P. falciparum infections to malaria transmission in high malaria-transmission areas and the need for molecular-based tools to detect submicroscopic Plasmodium species.

Analyzing childhood (0-59 months) malnutrition determinants in five West African Countries of Gabon, Gambia, Liberia, Mauritania, and Nigeria using survey logistic regression-insights from DHS data

BACKGROUND

Malnutrition is one of the most critical health challenges confronting public health agencies in developing nations. This study aimed to determine the scope and underlying factors contributing to malnutrition in West African countries, specifically Gabon, Gambia, Liberia, Mauritania, and Nigeria.

METHOD

For this secondary data analysis, this study drew upon the demographic and health surveys (DHS) conducted within these West African nations. These surveys employed a complex sampling design involving a combination of stratification and cluster sampling in two stages, with varying probabilities of selection leading to weighted samples that effectively represented different components of the population. Given the intricacies of this sampling design, it is paramount to account for them when analyzing the survey data. To address this concern, this study applied a survey logistic regression model, which accommodates factors such as stratification, clustering, and sampling weights and departs from the assumption of independence inherent in the ordinary logistic regression model.

RESULTS

The outcomes of this model revealed several variables that emerged as statistically significant (p < 0.05) determinants of malnutrition. These influential factors encompass the region of the respondent, the current age of the mother, the highest level of education attained by the mother, the source of drinking water, the type of toilet facility, the household's wealth status, the age and gender of the child, and whether the child experienced a fever in the preceding two weeks.

CONCLUSION

These findings demonstrate with poignant clarity the importance of primary health care interventions in the recognition and management of malnutrition. The countries of interest should invest in public health care interventions including community workshops and outreach programs. Workshops may occur at primary health care facilities during queue waits, or health workers may work with community leaders to perform workshops in areas of high foot traffic, such as places of worship, shopping hubs and collection points for financial aid or grants.

Malaria in under-five children: prevalence and multi-factor analysis of high-risk African countries

BACKGROUND

Malaria remains a significant public health challenge in Sub-Saharan Africa (SSA), particularly affecting under-five (UN5) children. Despite global efforts to control the disease, its prevalence in high-risk African countries continues to be alarming, with records of substantial morbidity and mortality rates. Understanding the association of multiple childhood, maternal, and household factors with malaria prevalence, especially among vulnerable young populations, is crucial for effective intervention strategies.

OBJECTIVE

This study examines the prevalence of malaria among UN5 children in selected high-risk SSA countries and analyzes its association with various childhood, maternal, and household factors.

METHODS

Data from the Malaria Indicator Surveys (MIS) spanning from 2010 to 2023 were analyzed. A weighted sample of 35,624 UN5 children from seven countries in sub-Saharan Africa (SSA) known for high malaria prevalence was considered in the analyses. Descriptive statistics and modified Poisson regression analysis were used to assess the association of multiple factors with malaria prevalence. Stata version 15 software was used in analyzing the data and statistical significance was set at a 5% significance level.

RESULTS

The overall pooled prevalence of malaria among the studied population was 26.2%, with substantial country-specific variations observed. In terms of child factors, a child's age was significantly associated with malaria prevalence (APR = 1.010, 95% CI: 1.007-1.012). Children of mothers with higher education levels (APR for higher education = 0.586, 95% CI: 0.425-0.806) and Fansidar uptake during pregnancy (APR = 0.731, 95% CI: 0.666-0.802) were associated with lower malaria risk. Children from middle-wealth (APR = 0.783, 95% CI: 0.706-0.869) and rich (APR = 0.499, 95% CI: 0.426-0.584) households had considerably lower malaria prevalence compared to those from poor households. Additionally, rural residency was associated with a higher risk of malaria compared to urban residency (APR = 1.545, 95% CI: 1.255-1.903).

CONCLUSION

The study highlights a notable malaria prevalence among under-five (UN5) children in high-risk SSA countries, influenced significantly by factors such as maternal education, Fansidar uptake during pregnancy, socioeconomic status, and residency. These findings underscore the importance of targeted malaria prevention strategies that address these key determinants to effectively reduce the malaria burden in this vulnerable population.

Malaria prevalence and use of control measures in an area with persistent transmission in Senegal

INTRODUCTION

In Senegal, the widespread use of vector control measures has resulted in a significant reduction in the malaria burden and led the country to consider the possibility of elimination. Given this shift and changing context, it is important to characterize the malaria burden across all age groups to guide decision-making on programmatic interventions to interrupt transmission and ultimately eradicate the disease. In Senegal, there is a lack of information on malaria prevalence among certain populations, particularly among adolescents and adults. This study sought to assess the magnitude of malaria infections in all age groups, as well as malaria associated factors in an area of persistent transmission in Senegal.

METHODS

A cross-sectional household survey was conducted in four health posts (Khossanto, Mamakhona, Diakhaling and Sambrambougou), of the health district of Saraya, in November 2021, among individuals over 6 months of age. Households were selected using multistage sampling. Consented participants were screened for malaria parasites by microscopic examination of blood smears, and hemoglobin levels were measured using the Hemocue HB 301TM analyzer. Socio-demographic information of the participants, household heads, household assets, and information on ownership and use of preventive measures were collected using a structured questionnaire. Weighted generalized mixed effects logistic regression model was used to identify factors associated with microscopically confirmed malaria infection.

RESULTS

A total of 1759 participants were enrolled in the study. Overall, about 21% of participants were classified as having Plasmodium infection; children aged 5-10 years old (26.6%), adolescents aged 10-19 years old (24.7%), and children under five years of age (20.5%) had higher rates of infection compared to adults (13.5%). Plasmodium falciparum accounted for 99.2% of the malaria infections, and most infections (69%) were asymptomatic. Around one-third of study participants had anemia (hemoglobin level <11.0 g/dl), with under five children bearing the highest burden (67.3%). Multivariate analysis showed that the odds of having a malaria infection were around 2 times higher among participants in Khossanto compared to Diakhaling (aOR = 1.84, 95% CI:1.06-3.20). Participants aged 5-9 years were more likely to have malaria infection compared to under five children (aOR = 1.40, 95% CI:1.02-1.91). Factors associated with anemia were P. falciparum infection (aOR = 1.36, p = 0.027), females (aOR = 2.16, p = 0.000), under-five age group (aOR = 13.01, p = 0.000).

CONCLUSION

Malaria burden was considerable among adolescents and under ten children living in an area of persistent transmission, with adolescents more commonly presenting as asymptomatic. Interventions tailored to this specific group of the population are needed to better control the disease and reduce its burden.

Modeling the shared risks of malaria and anemia in Rwanda

In sub-Saharan Africa, malaria and anemia contribute substantially to the high burden of morbidity and mortality among under-five children. In Rwanda, both diseases have remained public health challenge over the years in spite of the numerous intervention programs and policies put in place. This study aimed at understanding the geographical variations between the joint and specific risks of both diseases in the country while quantifying the effects of some socio-demographic and climatic factors. Using data extracted from Rwanda Demographic and Health Survey, a shared component model was conceived and inference was based on integrated nested Laplace approximation. The study findings revealed similar spatial patterns for the risk of malaria and the shared risks of both diseases, thus confirming the strong link between malaria and anaemia. The spatial patterns revealed that the risks for contracting both diseases are higher among children living in the districts of Rutsiro, Nyabihu, Rusizi, Ruhango, and Gisagara. The risks for both diseases are significantly associated with type of place of residence, sex of household head, ownership of bed net, wealth index and mother's educational attainment. Temperature and precipitation also have substantial association with both diseases. When developing malaria intervention programs and policies, it is important to take into account climatic and environmental variability in Rwanda. Also, potential intervention initiatives focusing on the lowest wealth index, children of uneducated mothers, and high risky regions need to be reinforced.

Age-specific malaria vulnerability and transmission reservoir among children

Purpose

The pediatric population, especially under-five children, is highly susceptible to malaria and accounts for 76 % of global malaria deaths according to the World Malaria Report 2022. The purpose of this manuscript is to discuss the various factors involved in the susceptibility of the pediatric population to Malaria and the importance of this age group for malaria elimination.

Methodology

Data on pediatric malaria epidemiology that includes prevalence, risk factors, immune factors, socioeconomic factors, control methods, etc. were extracted from published literature using PubMed and Google Scholar. This data was further correlated with malaria incidence data from the World Health Organization (WHO) and the National Center for Vector Borne Diseases Control (NCVBDC).

Results

The younger age group is vulnerable to severe malaria due to an immature immune system. The risk of infection and clinical disease increases after the waning of maternal immunity. In the initial years of life, the developing brain is more susceptible to malaria infection and its after-effects. The pediatric population may act as a malaria transmission reservoir due to parasite density and asymptomatic infections. WHO recommended RTS,S/AS01 has limitations and may not be applicable in all settings to propel malaria elimination.

Conclusion

The diagnosis of malaria is based on clinical suspicion and confirmed with microscopy and/or rapid diagnostic testing. The school-age pediatric population serves as a transmission reservoir in the form of asymptomatic malaria since they have acquired some immunity due to exposure in early childhood. Targeting the hidden reservoir in the pediatric population and protecting this vulnerable group will be essential for malaria elimination from the countries targeting elimination.

Unravelling factors associated with malaria parasitaemia among children 6-24 months to inform malaria interventions in Nigeria: evidence from 2021 Malaria Indicator Survey

BACKGROUND

As an additional two million malaria cases were reported in 2021 compared to the previous year, concerted efforts toward achieving a steady decline in malaria cases are needed to achieve malaria elimination goals. This work aimed at determining the factors associated with malaria parasitaemia among children 6-24 months for better targeting of malaria interventions.

METHODS

A cross-sectional study analysed 2021 Nigeria Malaria Indicator Survey dataset. Data from 3058 children 6-24 months were analyzed. The outcome variable was children 6-24 months whose parasitaemia was determined using a rapid diagnostic test (RDT). Independent variables include child age in months, mothers' age, mothers' education, region, place of residence, household ownership and child use of insecticide-treated net (ITN), exposure to malaria messages and knowledge of ways to prevent malaria. Logistic regression analysis was conducted to examine possible factors associated with malaria parasitaemia in children 6-24 months.

RESULTS

Findings revealed that 28.7% of the 3058 children aged 6-24 months tested positive for malaria by RDT. About 63% of children 12-17 months (aOR = 1.63, 95% CI 1.31-2.03) and 91% of children 18 to 24 months (aOR = 1.91, 95% CI 1.51-2.42) were more likely to have a positive malaria test result. Positive malaria test result was also more likely in rural areas (aOR = 1.79, 95% CI 2.02-24.46), northeast (aOR = 1.54, 95% CI 1.02-2.31) and northwest (aOR = 1.63, 95% CI 1.10-2.40) region. In addition, about 39% of children who slept under ITN had a positive malaria test result (aOR = 1.39 95% CI 1.01-1.90). While children of mothers with secondary (aOR = 0.40, 95% CI 0.29-0.56) and higher (aOR = 0.26, 95% CI 0.16-0.43) levels of education and mothers who were aware of ways of avoiding malaria (aOR = 0.69, 95% CI 0.53-0.90) were less likely to have a malaria positive test result.

CONCLUSION

As older children 12 to 24 months, children residing in the rural, northeast, and northwest region are more likely to have malaria, additional intervention should target them in an effort to end malaria.

Understanding the spatial non-stationarity in the relationships between malaria incidence and environmental risk factors using Geographically Weighted Random Forest: A case study in Rwanda

As found in the health studies literature, the levels of climate association between epidemiological diseases have been found to vary across regions. Therefore, it seems reasonable to allow for the possibility that relationships might vary spatially within regions. We implemented the geographically weighted random forest (GWRF) machine learning method to analyze ecological disease patterns caused by spatially non-stationary processes using a malaria incidence dataset for Rwanda. We first compared the geographically weighted regression (WGR), the global random forest (GRF), and the geographically weighted random forest (GWRF) to examine the spatial non-stationarity in the non-linear relationships between malaria incidence and their risk factors. We used the Gaussian areal kriging model to disaggregate the malaria incidence at the local administrative cell level to understand the relationships at a fine scale since the model goodness of fit was not satisfactory to explain malaria incidence due to the limited number of sample values. Our results show that in terms of the coefficients of determination and prediction accuracy, the geographical random forest model performs better than the GWR and the global random forest model. The coefficients of determination of the geographically weighted regression (R2), the global RF (R2), and the GWRF (R2) were 4.74, 0.76, and 0.79, respectively. The GWRF algorithm achieves the best result and reveals that risk factors (rainfall, land surface temperature, elevation, and air temperature) have a strong non-linear relationship with the spatial distribution of malaria incidence rates, which could have implications for supporting local initiatives for malaria elimination in Rwanda.

Non-falciparum malaria infection and IgG seroprevalence among children under 15 years in Nigeria, 2018

Plasmodium falciparum (Pf) is the dominant malaria parasite in Nigeria though P. vivax (Pv), P. ovale (Po), and P. malariae (Pm) are also endemic. Blood samples (n = 31,234) were collected from children aged 0-14 years during a 2018 nationwide HIV survey and assayed for Plasmodium antigenemia, Plasmodium DNA, and IgG against Plasmodium MSP1-19 antigens. Of all children, 6.6% were estimated to have Pm infection and 1.4% Po infection with no Pv infections detected. The highest household wealth quintile was strongly protective against infection with Pm (aOR: 0.11, 95% CI: 0.05-0.22) or Po (aOR= 0.01, 0.00-0.10). Overall Pm seroprevalence was 34.2% (95% CI: 33.3-35.2) with lower estimates for Po (12.1%, 11.6-12.5) and Pv (6.3%, 6.0-6.7). Pm seropositivity was detected throughout the country with several local government areas showing >50% seroprevalence. Serological and DNA indicators show widespread exposure of Nigerian children to Pm with lower rates to Po and Pv.

Is the presence of mosquitoes an indicator of poor environmental sanitation?

The World Health Organization has designated mosquitoes as the most lethal animal since they are known to spread pathogen-transmitting organisms. Understanding the many environmental elements that contribute to the spread of these vectors is one of the many strategies used to stop them. If there are mosquitoes around people, it may indicate that there is not an appropriate environmental sanitation program in place in the community or region. Environmental sanitation involves improving any elements of the physical environment that could have a negative impact on a person's survival, health, or physical environment. Keywords containing 'Aedes,' 'Culex,' 'Anopheles,' 'dengue,' 'malaria,' 'yellow fever,' 'Zika,' 'West Nile,' 'chikungunya,' 'resident,' 'environment,' 'sanitation,' 'mosquito control,' and 'breeding sites' of published articles on PubMed, Google Scholar, and ResearchGate were reviewed. It was discovered that the general population should be involved in mosquito and mosquito-borne disease control. Collaboration between health professionals and the general population is essential. The purpose of this paper is to increase public awareness of environmental health issues related to diseases carried by mosquitoes.

Malaria amongst children under five in sub-Saharan Africa: a scoping review of prevalence, risk factors and preventive interventions

INTRODUCTION

Africa has a higher burden of malaria-related cases and deaths globally. Children under five accounted for over two-thirds of all malaria deaths in sub-Saharan Africa (SSA). This scoping review aims to map evidence of the prevalence, contextual factors and health education interventions of malaria amongst children under 5 years (UN5) in SSA.

METHOD

Four main databases (PubMed, Central, Dimensions and JSTOR) produced 27,841 records of literature. Additional searches in Google, Google Scholar and institutional repositories produced 37 records. Finally, 255 full-text records were further screened, and 100 records were used for this review.

RESULTS

Low or no formal education, poverty or low income and rural areas are risk factors for malaria amongst UN5. Evidence on age and malnutrition as risk factors for malaria in UN5 is inconsistent and inconclusive. Furthermore, the poor housing system in SSA and the unavailability of electricity in rural areas and unclean water make UN5 more susceptible to malaria. Health education and promotion interventions have significantly reduced the malaria burden on UN5 in SSA.

CONCLUSION

Well-planned and resourced health education and promotion interventions that focus on prevention, testing and treatment of malaria could reduce malaria burden amongst UN5 in SSA.

Malaria profile and socioeconomic predictors among under-five children: an analysis of 11 sub-Saharan African countries

BACKGROUND

African region accounts for 95% of all malaria cases and 96% of malaria deaths with under-five children accounting for 80% of all deaths in the region. This study assessed the socioeconomic determinants of malaria prevalence and provide evidence on the socioeconomic profile of malaria infection among under-five children in 11 SSA countries.

METHODS

This study used data from the 2010 to 2020 Demographic and Health Survey (DHS). The survey used a two-stage stratified-cluster sampling design based on the sampling frame of the population and housing census of countries included. Statistical analyses relied on Pearson's χ2, using the CHAID decision-tree algorithm and logistic regression implemented in R V.4.6.

RESULTS

Of 8547 children considered, 24.2% (95% confidence interval CI 23.4-25.05%) had malaria infection. Also, the prevalence of malaria infection seems to increase with age. The following variables are statistically associated with the prevalence of malaria infection among under-five children: under-five child's age, maternal education, sex of household head, household wealth index, place of residence, and African region where mother-child pair lives. Children whose mothers have secondary education have about 56% lower risk (odds ratio = 0.44; 95% CI 0.40-0.48) of malaria infection and 73% lower (odds ratio = 0.37; 95% CI 0.32-0.43) among children living in the richest households, compared to children living in the poorest households.

CONCLUSIONS

The findings of this study provide unique insights on how socioeconomic and demographic variables, especially maternal education level significantly predicts under-five malaria prevalence across the SSA region. Therefore, ensuring that malaria interventions are underpinned by a multisectoral approach that comprehensively tackles the interplay of maternal education and other socioeconomic variables will be critical in attaining malaria prevention and control targets in SSA.

"A comparative analysis of risk factors of malaria" case study Gisagara and Bugesera District of Rwanda. RDHS 2014/2015. A retrospective study

BACKGROUND

Malaria is a public health concern worldwide. A figure of 3.2 billion people is at risk of malaria a report of World Health Organization in 2013. A proportion of 89 and 91 cases of malaria reported during 2015 were respectively attributed to malaria cases and malaria deaths in Sub-Saharan Africa. Rwanda is among the Sub-Saharan Africa located in East Africa. The several reports indicate that from 2001 to 2011, malaria cases increased considerably especially in Eastern and Southern Province with five million cases. The affected districts included Bugesera in the Eastern and Gisagara in the Southern Province of Rwanda with a share of 41% of the country prevalence in 2014 and during 2017-2018 a figure of 11 deaths was attributed to malaria and both Gisagara and Bugesera Districts were the high burdened.

METHODOLOGY

The RDHS 2014-2015 data was used for the study and a cross-sectional survey was used in which two clusters were considered both Gisagara and Bugesera Districts in the Southern and Eastern Province of Rwanda. Bivariate analysis was used to determine the significant predictors with malaria and reduced logistic regression model was used.

RESULTS

The results of the study show that not having mosquito bed nets for sleeping is 0.264 times less likely of having malaria than those who have mosquito bed nets in Gisagara District. In Bugesera District, living in low altitude is 2.768 times more likely associated with the risk of getting malaria than living in high altitude.

CONCLUSION

The results of the study concluded that environmental and geographical factor such as low altitude is the risk factor associated with malaria than the high altitude in Bugesera District. While not having mosquito bed nets for sleeping is the protective factor for malaria than those who have it in Gisagara District. On the other hand, socio-economic and demographic characteristics do not have any effect with malaria on the results of the study.

Effectiveness of indoor residual spraying on malaria control: a systematic review and meta-analysis

Background

Indoor residual spraying (IRS) is one of the key interventions recommended by World Health Organization in preventing malaria infection. We aimed to conduct a systematic review and meta-analysis of global studies about the impact of IRS on malaria control.

Method

We searched PubMed, Web of Science, Embase, and Scopus for relevant studies published from database establishment to 31 December 2021. Random-effects models were used to perform meta-analysis and subgroup analysis to pool the odds ratio (OR) and 95% confidence interval (CI). Meta-regression was used to investigate potential factors of heterogeneity across studies.

Results

Thirty-eight articles including 81 reports and 1,174,970 individuals were included in the meta-analysis. IRS was associated with lower rates of malaria infection (OR = 0.35, 95% CI: 0.27–0.44). The significantly higher effectiveness was observed in IRS coverage ≥ 80% than in IRS coverage < 80%. Pyrethroids was identified to show the greatest performance in malaria control. In addition, higher effectiveness was associated with a lower gross domestic product as well as a higher coverage of IRS and bed net utilization.

Conclusions

IRS could induce a positive effect on malaria infection globally. The high IRS coverage and the use of pyrethroids are key measures to reduce malaria infection. More efforts should focus on increasing IRS coverage, developing more effective new insecticides against malaria, and using multiple interventions comprehensively to achieve malaria control goals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-01005-8.

Treatment outcome and factors associated with mortality due to malaria in Munini District Hospital, Rwanda in 2016-2017: Retrospective cross-sectional study

Introduction

Malaria is a major public health burden in developing countries despite efforts made by several countries. This disease leads to high morbidity and mortality among Rwandans, particularly in the Southern Province where it was the sixth national cause of morality; at Munini hospital it is the first cause of mortality, but the associated factors remain unknown. In this study, we determined the factors associated with deaths among patients with severe malaria to come up with evidence-based interventions to prevent malaria and its factors.

Methods

A retrospective cross-sectional study was conducted on malaria patients who were treated at the Munini District Hospital from 2016 to 2017. Data were collected from the hospital records or registers relating to patients who were admitted with severe malaria. The odds ratio was estimated by bivariate logistic regression and multivariate hierarchical regression models for determining the associated factors of deaths. Data were analyzed using STATA/MP Version 14.1 and Epi-info with proportions.

Results

The study population were mostly women (n = 237, 59.1%), farmers (n = 313, 78.05%), aged 16-30 years (n = 107, 26.68%). Our results indicated that the majority of deaths were women (56.25%). Socio-economic and clinical determinants are important predictors of death among patients with severe malaria. Patients with coma had higher odds of dying (AOR = 7.31, 95% CI :3.33-16.1, p < 0.001) than those who were not. The possibility of mortality increased by almost four times in patients who delayed consultation by a day (AOR = 3.7, 95%CI:1.8-4.1; p < 0.001) compared to those who came in very early. Patients who had severe malaria in the dry season were at a lower risk of mortality (AOR = 0.23, 95%CI:0.08-0.64, p = 0.005) compared to those with severe malaria during the rainy season.

Conclusion

Lack of health insurance, age of the patient, delayed diagnosis, coma, proximity and access to healthcare services, and weather conditions were the major factors associated with mortality among patients with severe malaria. Comprehensive, long-term, equity-based healthcare interventions and immediate care strategies are recommended.

Population knowledge, attitudes and practices towards malaria prevention in the locality of Makenene, Centre-Cameroon

Background

To contribute to the mission of the National Malaria Control Programme (NMCP) and guide future interventions in Cameroon in general, and in Makenene in particular, this study assessed the knowledge, attitudes and practices of the population of Makenene towards the fight against malaria.

Methods

Using a semi-structured questionnaire, a descriptive cross-sectional household community survey was carried out in randomly selected households in Makenene, a locality situated between forest and savannah ecotypes.

Results

Out of the 413 households surveyed, all (100%) claimed to have heard of malaria with over 94% (n = 391) associating disease transmission with mosquito bites. The main mosquito control tools used in the area were mosquito nets (92.25%). The majority of participants had good knowledge (55.93%; n = 231), good practices (71.67%, n = 296) but moderate attitudes (47.94%; n = 198) towards malaria control and fight. Good knowledge and practices were recorded mostly in educated persons including public servants and students. Good attitudes were adopted mostly by public servants and students of secondary and higher levels of education.

Conclusion

In Makenene, the population exhibits good knowledge and practices towards malaria and its control. However, despite high LLINs ownership and use, people still complain about malaria in the area. Control tools should be monitored, repaired or replaced when necessary to support the achievement of the NMCP mission.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04253-z.

Malaria-associated risk factors among adolescents living in areas with persistent transmission in Senegal: a case-control study

BACKGROUND

In Senegal, malaria morbidity has sharply decreased over these past years. However, malaria epidemiology remains heterogeneous with persistent transmission in the southeastern part of the country and many cases among older children and adolescents. Little is known about factors associated with clinical malaria among this group. A better understanding of malaria transmission among this newly emerging vulnerable group will guide future interventions targeting this population group. This study aimed to identify factors associated with clinical malaria among adolescents in Senegal.

METHODS

A case-control study was conducted from November to December 2020 in four health posts located in the Saraya district. Cases were defined as adolescents (10-19 years) with an uncomplicated malaria episode with fever (temperature > 37.5°) or a history of fever and positive malaria rapid diagnostic test (RDT). Controls were from the same age group, living in the neighbourhood of the case, presenting a negative RDT. A standardized, pre-tested questionnaire was administered to each study participant followed by a home visit to assess the participant's living conditions. Factors associated with clinical malaria were assessed using stepwise logistic regression analysis.

RESULTS

In total, 492 individuals were recruited (246 cases and 246 controls). In a multivariate analysis, factors associated with clinical malaria included non-use of long-lasting insecticidal net (LLIN) (aOR = 2.65; 95% CI 1.58-4.45), non-use of other preventive measures (aOR = 2.51; 95% CI 1.53-4.11) and indoor sleeping (aOR = 3.22; 95% CI 1.66-6.23). Protective factors included 15-19 years of age (aOR = 0.38; 95% CI 0.23-0.62), absence of stagnant water around the house (aOR = 0.27; 95% CI 0.16-0.44), having a female as head of household (aOR = 0.47; 95% CI 0.25-0.90), occupation such as apprentice (OR = 0.24; 95% CI 0.11-0.52).

CONCLUSIONS

The study revealed that environmental factors and non-use of malaria preventive measures are the main determinants of malaria transmission among adolescents living in areas with persistent malaria transmission in Senegal. Strategies aimed at improving disease awareness and access to healthcare interventions, such as LLINs, are needed to improve malaria control and prevention among these vulnerable groups.

Attributable risk factors for asymptomatic malaria and anaemia and their association with cognitive and psychomotor functions in schoolchildren of north-eastern Tanzania

In Africa, children aged 5 to 15 years (school age) comprises more than 50% (>339 million) of the under 19 years population, and are highly burdened by malaria and anaemia that impair cognitive development. For the prospects of improving health in African citizens, understanding malaria and its relation to anaemia in school-aged children, it is crucial to inform targeted interventions for malaria control and accelerate elimination efforts as part of improved school health policy. We conducted a study to determine the risk factors for asymptomatic malaria and their association to anaemia. We explored the prevalence of antimalarial drug resistance as well as the association of asymptomatic malaria infection and anaemia on cognitive and psychomotor functions in school-aged children living in high endemic areas. This study was a comprehensive baseline survey, within the scope of a randomised, controlled trial on the effectiveness and safety of antimalarial drugs in preventing malaria and its related morbidity in schoolchildren. We enrolled 1,587 schoolchildren from 7 primary schools located in Muheza, north-eastern Tanzania. Finger-pricked blood samples were collected for estimation of malaria parasitaemia using a microscope, haemoglobin concentration using a haemoglobinometer, and markers of drug resistance processed from dried blood spots (DBS). Psychomotor and Cognitive functions were assessed using a '20 metre Shuttle run' and a test of everyday attention for children (TEA-Ch), respectively. The prevalence of asymptomatic malaria parasitaemia, anaemia and stunting was 26.4%, 49.8%, and 21.0%, respectively with marked variation across schools. In multivariate models, asymptomatic malaria parasitaemia attributed to 61% of anaemia with a respective population attribution fraction of 16%. Stunting, not sleeping under a bednet and illiterate parent or guardian were other factors attributing to 7%, 9%, and 5% of anaemia in the study population, respectively. Factors such as age group (10-15 years), not sleeping under a bednet, low socioeconomic status, parents' or guardians' with a low level of education, children overcrowding in a household, and fewer rooms in a household were significantly attributed to higher malaria infection. There was no significant association between malaria infection or anaemia and performance on tests of cognitive function (sustained attention) or psychomotor function (VO2 max). However, a history of malaria in the past one month was significantly associated with decreased cognitive scores (aOR = -4.1, 95% CI -7.7-0.6, p = 0.02). Furthermore, stunted children had significantly lower VO2max scores (aOR = -1.9, 95% CI -3.0-0.8, p = 0.001). Regarding the antimalarial drug resistance markers, the most prevalent Pfmdr1 86-184-1034-1042-1246 haplotypes were the NFSND in 47% (n = 88) and the NYSND in 52% (n = 98). The wild type Pfcrt haplotypes (codons 72-76, CVMNK) were found in 99.1% (n = 219) of the samples. Malaria, stunting and parents' or guardians' illiteracy were the key attributable factors for anaemia in schoolchildren. Given malaria infection in schoolchildren is mostly asymptomatic; an addition of interventional programmes such as intermittent preventive treatment of malaria in schoolchildren (IPTsc) would probably act as a potential solution while calling for an improvement in the current tools such as bednet use, school food programme, and community-based (customised) health education with an emphasis on nutrition and malaria control.

When Local Trade-Offs between SDGs Turn Out to Be Wealth-Dependent: Interaction between Expanding Rice Cultivation and Eradicating Malaria in Rwanda

Interactions between SDGs are increasingly mapped and mediating factors that determine whether existing synergies or trade-offs can be identified. However, if and how the wealth status of the concerned population shapes whether SDG interaction constitutes a vicious or virtuous circle is largely overlooked. This article focuses on interaction between SDG2 (nutrition) and SDG3 (health), in particular, the relationship between rice production intensification and the fight against malaria, and thus the role of wealth in explaining the trade-off. This study employed a large-scale survey of rural households (n = 3968) in eastern Rwanda, conducted at a time when a rapid expansion of rice fields co-existed with a strong resurgence of malaria. Logistic regression shows that rice-cultivating households faced significant higher malaria risk, as proxied by fever incidence, confirming the negative externality of agricultural intensification on public health through offering a habitat for vector-borne diseases. Even though rice-cultivating households tend to be higher up the local wealth distribution than those outside the rice sector, its distributional effects are generally biased against the poor. Poorer households outside the rice sector hardly share in the benefits from increased rice production but suffer the consequences in terms of increased malaria risk. The case thus draws attention to the importance of using a distributional lens when analyzing interaction between SDGs locally.

Five-Year Trend of Malaria Prevalence in Mojo Town, Central Ethiopia: Shifting Burden of the Disease and Its Implication for Malaria Elimination: A Retrospective Study

Introduction

Malaria continues to strike hardest against the health and economic development in Ethiopia. The peak of malaria incidence follows the main rainfall season in each year; however, its transmission tends to be highly heterogeneous within or between years and from area to area. Thus, this study was aimed to determine the trend prevalence of malaria in Mojo town, central Ethiopia.

Methods

A retrospective study was conducted in Mojo town, East Shoa zone, Ethiopia from February to March 2021. Malaria cases and related data documented between 2016 and 2020 were carefully reviewed from laboratory registration logbooks. The collected data were analyzed using descriptive statistics.

Results

A total of 19,106 blood films were examined from malaria-suspected patients. The overall microscopically confirmed prevalence of malaria was 4.2% (793/19,106). Plasmodium vivax was the predominant species accounting for 76.2% (604/793) of positive samples. Malaria cases declined from 259 in 2016 to 77 in 2020. The proportion of malaria was higher among males (64.8%, 514/793) than females (35.2%, 279/793) (P < 0.0001). Higher malaria cases were observed from the age group 15–24 years followed by the age group of 25–34 (P < 0.0001). The number of malaria cases was at a high level from September to November and lowest from December to February.

Conclusion

Despite a declining trend of malaria prevalence, it remains a public health burden in the area. P. vivax, the predominant species, should get attention during prevention and control strategies for the successful progress of the malaria elimination program.

Prevalence of Malaria and Associated Factors Among Children Attending Health Institutions at South Gondar Zone, Northwest Ethiopia: A Cross-Sectional Study

Malaria is a fatal disease among children in malaria-prone locations such as Addis Zemen and Woreta because of their weak immune systems. Despite the severity of the disease in children, the majority of research conducted in Ethiopia has focused on adult populations rather than children. Furthermore, there is no data on malaria prevalence, risk factors, or parasite density among children in the Addis Zemen and Woreta catchment areas. Therefore, this study was aimed at filling the above gap in the study area. About 422 children were enrolled in the study by systematic sampling technique. A capillary blood sample was collected from each child to do blood film. The overall prevalence of malaria among children attending South Gonder health institutions was 14.7%. The majority of parasite density was moderate parasitemia followed by low parasitemia, giving 71.0% and 16.0%, respectively. Malaria parasite infection was linked to a history of malaria and the presence of stagnant water near a home, but utilization of insecticide-treated bed nets was found to be protective against the infection. Therefore, health education should be strengthened on proper utilization of bed nets, indoor residual spraying, removing stagnant water by discarding old tires that may collect rainwater, and removing debris from streams so streams flow more freely.

Epidemiological Trends of Malaria in Five Years and under Children of Nsanje District in Malawi, 2015-2019

Background: Malaria continues to be a major public health problem in Malawi and the greatest load of mortality and morbidity occurs in children five years and under. However, there is no information yet regarding trends and predictions of malaria incidence in children five years and under at district hospital level, particularly at Nsanje district hospital. Aim: Therefore, this study aimed at investigating the trends of malaria morbidity and mortality in order to design appropriate interventions on the best approach to contain the disease in the near future. Methodology: Trend analysis of malaria morbidity and mortality together with time series analysis using the SARIMA (Seasonal Autoregressive Integrated Moving Average) model was used to predict malaria incidence in Nsanje district. Results: The SARIMA model used malaria cases from 2015 to 2019 and created the best model to forecast the malaria cases in Nsanje from 2020 to 2022. An SARIMA (0, 1, 2) (0,1,1)₁₂ was suitable for forecasting the incidence of malaria for Nsanje. Conclusion: The mortality and morbidity trend showed that malaria cases were growing at a fluctuating rate at Nsanje district hospital. The relative errors between the actual values and predicted values indicated that the predicted values matched the actual values well. Therefore, the model proved that it was adequate to forecast monthly malaria cases and it had a good fit, hence, was appropriate for this study

Systematic Evolution of Ligands by Exponential Enrichment Technologies and Aptamer-Based Applications: Recent Progress and Challenges in Precision Medicine of Infectious Diseases

Infectious diseases are considered as a pressing challenge to global public health. Accurate and rapid diagnostics tools for early recognition of the pathogen, as well as individualized precision therapy are essential for controlling the spread of infectious diseases. Aptamers, which were screened by systematic evolution of ligands by exponential enrichment (SELEX), can bind to targets with high affinity and specificity so that have exciting potential in both diagnosis and treatment of infectious diseases. In this review, we provide a comprehensive overview of the latest development of SELEX technology and focus on the applications of aptamer-based technologies in infectious diseases, such as targeted drug-delivery, treatments and biosensors for diagnosing. The challenges and the future development in this field of clinical application will also be discussed.

Prevalence, Parasite Density and Determinants of Falciparum Malaria Among Febrile Children in Some Peri-Urban Communities in Southwestern Nigeria: A Cross-Sectional Study

Background

Malaria remains a serious public health problem worldwide, particularly in tropical and subtropical regions, including Nigeria. This study investigates the prevalence, parasite density and determinants of malaria among symptomatic children in some peri-urban communities in southwestern Nigeria.

Methods

This was a randomized cross-sectional and hospital-based study. The standard method of microscopy was employed. Thick and thin films were prepared and viewed under a light microscope to identify and quantify malaria parasites. A well-structured and pre-tested questionnaire was used to obtain the subject’s information on the demographic, socio-economic and environmental variables.

Results

A total of 380 (71.7%) participants were infected with Plasmodium falciparum with a mean parasite density of 1857.11 parasite/µL of blood. Malaria prevalence and mean parasite density were significantly higher among male compared to their female counterparts [80.3% vs 61.4% and 2026.46 vs 1619.63 parasite/µL of blood]. Similarly, age group ≤5 years had the highest malaria prevalence (92.2%) and mean parasite density (2031.66 parasite/µL of blood) than other age groups (AOR 2.281, 95% CI: 1.187–4.384, P < 0.05). The multivariate logistic analysis showed that malaria disease is significantly associated with having mother with no formal education (AOR 12.235, 95% CI: 3.253–46.021, P < 0.05), having well and river as a major source of household water supply (AOR 13.810, 95% CI: 3.012–63.314, P < 0.05 vs AOR 5.639, 95% CI: 1.455–21.853, P < 0.05) and presence of stagnant water around home (AOR 5.22, 95% CI: 2.921–9.332, P < 0.05). Furthermore, protective factors observed include ownership of mosquito bed net (AOR 0.474, 95% CI: 0.223–1.008, P < 0.05) and distance of home to hospital (AOR 0.279, 95% CI: 0.158–0.493, P < 0.05).

Conclusion

Malaria remains a serious public health problem in the study area. Adopting integrated malaria control measures including educating parents on malaria prevention and control strategies, distributing mosquito bed nets, and establishing larvae source management program is highly imperative.